Obinutuzumab, Venetoclax and Vaccines

[carolly]

Hello, I’m just starting month 3 of O+V treatment and I asked my consultant about this years Flu and Covid boosters. He replied that whilst I was on Obinutuzumab any antibodies I made would be completely wiped out by the treatment, which makes perfect sense. What are O+V people doing this autumn? Are you waiting till after Obinutuzumab finishes, if so, how long after?Thank you and all the best for your treatments Carol x

[carnvellan]

Hi carolly - I'm in month 7 of the same programme. I've had 5 covid vaccinations and my recent antibody test showed no antibodies - well 0.8 actually! My consultant was not at all surprised. Her view is that no new vaccination will give me antibodies until I finish the course in February. I do not know how long I must wait thereafter before it's worth having a vaccination.

I am asking the question now whether, as well as wiping out covid vaccine antibodies, is the O&V knocking out antibodies of all previous vaccinations apart from Covid? My consultant was unable to say but thought that memory cells in our bodies should recognise infections like chickenpox which we mostly all had years ago. It's quite a worry.

[carolly in reply to carnvellan]

Hi yes it’s good point. I tried to read which B cells are taken out and (I think) plasma cells which have been activated by having a specific disease can remain and still protect, but all others are gone. I may need to be corrected! x

[Fergusaims in reply to carolly]

Hi, I finished O&V at the end of May & in April, after 5 COVID vaccs got tested & had no antbodies.

[SofiaDeo]

I am choosing to get flu & Covid vaccines for any potential benefit besides antibodies. T-cells might get some stimulation, and since I do not have side effects or problems with vaccines generally, I am willing to get them in case they are helpful. If I were one of those who gets adverse reactions or side effects, I might think differently.

[CycleWonder]

According to previous posts on this issue, it may take a year after your last dose of O for your immune system to fully recover. I am interpreting this to mean that for a year after my last dose of O (which I have not started), I need to be very careful. My T cells should be OK, allowing my body to blast virus-infected cells. But my antibodies will be ineffective at killing viruses in my bloodstream.

[carolly in reply to CycleWonder]

It has made me reconsider how much interaction I will have with people this autumn and winter and I really don’t fancy a trip abroad right now.

[AussieNeil Administrator]

I'm in a clinical trial and am having 3 monthly follow-up appointments. Preparatory to them, my clinical trial specialist sometimes runs two tests; Immunophenotyping and Lymphocyte Subsets. From those reports, I get to see the various lymphocyte counts. Up until 20 months after my final obinutuzumab infusion and 15 months after my last acalabrutinib and venetoclax dose, I registered <1% B cells. Thereafter they gradually began to increase, but 20 months after finishing the treatment phase, my B cells are still only at 3% of my lymphocyte count. Normal range is 3 to 30% of the lymphocyte count.

I did have the annual flu shot while on treatment and the pharmacist recommended a booster later in the year, which initially appealed to me. However thanks to government mandates and guidelines, Australia had virtually no flu cases in 2020 or 2021 and I was shielding, given my vulnerability. This year, with the general opinion that the pandemic is over, we've had the worst flu season as far as online records go back and our COVID-19 death rate has been among the top 5 country death rates for quite a few months. Go figure!

Neil

[Cate445 in reply to AussieNeil]

Thank you Aussie Neil this is really helpful .

[patagozon]

I will be starting treatment with V+O in three weeks. I just met with a CLL specialist and he recommended a COVID shot before starting treatment. Having read on this forum that Obinutuzumab renders the vaccine ineffective, I was left confused why it was recommended. He also recommended I get Evusheld before beginning treatment. Does Obinutuzumab have any impact on the effectiveness of Evusheld?

[carolly in reply to patagozon]

I understand Evusheld comprises two long acting antibodies but I need someone more informed than me to say if they get past Obinutuzumab! Best wishes for your treatment x

[AussieNeil Administrator in reply to carolly]

Relax carolly and patagozon ! Obinutuzumab kills CLL cells, not antibodies/immunoglobulins, which are made by mature B cells called plasma cells. If Obinutuzumab destroyed antibodies, then as soon as we started on it, our IgA, IgG and IgM would plummet and we'd lose our very effective protection against past illnesses along with that from all our past vaccinations and that doesn't happen.

Patagozon, Your CLL specialist was right to recommend that you have your COVID-19 vaccine before starting treatment. If you leave at least two weeks before you start treatment after your vaccination, your B cells responding to your vaccination will have time to mature into antibody producing plasma cells, giving you protection. If you have vaccinations after starting treatment, the treatment will most likely kill off the naive B cells needed to respond to vaccinations. Thankfully mature B cells have much less susceptibility to CLL treatments than naive and maturing B cells.

Neil

[patagozon in reply to AussieNeil]

Thanks for the explanation. That makes sense - I just didn't want to waste the money (in this case the government's money) on a booster shot or Evusheld if it wasn't going to help.

[carolly]

Great explanation, thanks!